Deirdre Bonnycastle's Blog on Teaching in Medicine

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How Do People Learn to Do X?

In my basic teaching classes, I talk about the “5 Step Approach to Teaching Skills and Procedures” but I don’t usually talk about why this technique works better than simply telling someone how to do X. I recently was looking at an article about flipping the classroom that asked can you learn to fold an origami crane by watching a video once. The answer of course is no. Try it by watching the linked video above. Why is it impossible? Does previous origami experience make the doing easier?

STEPS

Unless you are one of the unique individuals with an eidetic memory, the video moves too quickly for you to remember the steps as distinct units in the process. This is a similar issue if you are told how to do X verbally, most novices will not be able to remember a series of steps after leaving the room even if it seems very clear to them when they are told. Even if you have folded cranes previously, the majority of people who don’t do origami regularly will have forgotten the steps.

The advantage of video instruction over verbal instruction is you can watch the video numerous times in order to practice as you go along. If you prefer the big picture, you can watch the entire video before trying the individual steps. If you are a trees person, you can stop it at each step and make notes or practice the first time you watch.

Novice vs. Expert Memory

When experts demonstrate X, it looks easy (because it is to the expert) and novice minds are often fooled into thinking that they can do it as readily. The problem is that most procedures physicians do involve both intellectual and muscle memory, only repeated supervised physical practice creates muscle memory. Someone with previous experience doing similar tasks has a jump start on the muscle memory. In the crane example, someone with previous origami experience will find the basic folds easier to follow. Muscle memory seems to take longer to lose than intellectual memory. For example, you will often remember how to do an origami fold longer than you will remember the name of the fold.

Supervised Practice

Novice practitioners don’t know what they don’t know and can repeat errors over and over without knowing why they are wrong. This group needs regular feedback until they are minimally efficient. Supervision can be gradually withdrawn after that.

People with some experience need initial supervision because there may be required terminology or steps they have forgotten especially if they haven’t done X in a while. For example, when I watched the video I had forgotten what a mountain fold was and how to do it. Watching the video didn’t help and I needed to either ask someone or look it up in a different milieu.